- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $2,630.27 / $6,606.93
| Facility | | $1,000.00 | $2,630.27 | $6,606.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $181.97 / $741.31
| Professional | | $138.04 | $181.97 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.04 / $3,890.45 / $10,471.29
| Facility | | $138.04 | $3,890.45 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $204.17 / $1,513.56
| Professional | | $151.36 | $204.17 | $1,513.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,621.81 / $5,754.40 / $10,715.19
| Facility | | $1,621.81 | $5,754.40 | $10,715.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $194.98 / $269.15
| Professional | | $144.54 | $194.98 | $269.15 |